Child welfare-involved youth with intellectual disabilities: Pathways into and placements in foster care

As I have worked to merge my interests in disability and child welfare, I have started to draw on data from the Adoption and Foster Care Reporting System (AFCARS). Recently, I worked with Dr. Cheryl Springer on a study about pathways into foster care for children with intellectual disabilities…to get a taste of what we found, here is the abstract from our article, published in 2011 in the journal Intellectual/Developmental Disabilities.

Existing literature suggests that youth with intellectual disabilities are known to be at increased risk of maltreatment in the form of abuse or neglect. Little is known, however, about youth with intellectual disabilities who are living in foster care or who are supervised by child welfare authorities. This study establishes a baseline estimate of the prevalence of youth with intellectual disabilities living in foster care, documents reasons for child welfare system involvement and identifies placement types while youth are in care.

This cross-sectional, exploratory study draws on data from the Adoption and Foster Care Reporting System (AFCARS) for foster youth in 46 states, the District of Columbia and Puerto Rico. A sample of youth with intellectual disabilities (N=17,714) and a comparison group without intellectual disabilities (N=655,536) were identified for 1999.

Youth with intellectual disabilities constituted 2.6 percent of the entire foster care population represented in AFCARS. With respect to base demographics, youth with intellectual disabilities were on average two years older than their counterparts and were more likely to be male. Youth with intellectual disabilities aged 12-19 constituted half (50.2 percent) of the sample, with latency-aged youth constituting a 25.6 percent, 0-3 year olds constituting 11.8 percent and 4-6 year olds constituting 10.9 percent. Findings related to race and ethnicity suggest that the sample was slightly more likely to be characterized as African American, but less likely to be characterized as American Indian/Alaskan Native, Asian/Pacific Islander, Caucasian or Hispanic/Latino/a. Youth with intellectual disabilities are known to have a higher likelihood of additional co-morbidities and/or special health care needs (Horwitz, Kerker, Owens and Zigler, 2000). In this sample of youth with intellectual disabilities, the presence of co-morbid disabilities or medical conditions followed this pattern, with the odds of having these conditions at between four and twenty times that of the comparison group.

Looking at whether foster youth had a history of CPS involvement, 76.3 percent of all foster youth with intellectual disabilities were experiencing their first removal episode in 1999, a rate comparable their counterparts (79.3 percent). Foster youth with intellectual disabilities had only very slightly higher mean numbers of lifetime removals (1.4 vs. 1.3, t=6.4, p<.001) and had only a very slightly higher age at first removal than their counterparts (7.1 years vs. 6.9 years, t=5.59, p<.001). On average, they had two more years since their first removal (3 vs. 2, t=7.30, p<.001)and had lived in foster care for 1.5 years longer than their counterparts during the current removal episode (3 years vs. 1.5 years, t=7.62, p<.001). Foster youth with intellectual disabilities were more likely to have been adopted previously (2.5 percent vs. 1.8 percent, OR=1.37, p<.001), suggesting another proxy measure of previous CPS involvement.

Whether or not youth have had prior involvement with CPS systems, the manner in which a child is removed from their family as a result of suspected abuse or neglect may be an indicator of the potential severity of the trauma experienced. Although a majority of youth with intellectual disabilities were placed with CPS voluntarily during their most recent or current removal episode, this removal type was less likely for youth with intellectual disabilities (88.4 percent vs. 91.6 percent). Looking at court-ordered removals, approximately ten percent of all youth experienced this, although youth with intellectual disabilities were more likely to be removed this way (11.6 percent vs. 8.4 percent, OR=1.34, p<.001).

Removal-related characteristics and comparisons: With respect to reasons for a child’s removal during the current foster care episode, neglect emerged as the primary reason that youth were removed, at just under fifty vs. sixty percent (see Table 3). Our findings also suggested types of removal which may be less common among youth with intellectual disabilities; these types included abandonment, parental incarceration, their own behavior problems (including alcohol or drug abuse) or parental drug abuse. No differences were noted between youth with and without intellectual disabilities with respect to removals initiated due to “parental inability to cope” or parental alcohol abuse. Youth with intellectual disabilities were more likely than youth without intellectual disabilities to be removed due to relinquishment, parental death, “their disability,” sexual abuse or physical abuse.

Given existing research that is suggestive of gender differences in sexual and physical abuse among youth with intellectual disabilities, we conducted three sets of analyses within the populations of foster youth explored herein. Looking just at foster youth with intellectual disabilities, our data suggest that girls are two times more likely to experience removal due to sexual abuse than are boys (OR=2.09, p<.001) but evidenced no gender differences in the likelihood of physical abuse. Then, in order to assess for between group gender differences, we examined the odds of removal due to sexual abuse among girls, finding that girls with intellectual disabilities were 58 percent more likely to be removed for this reason (OR=1.58, p<.001). In order to assess for between group gender differences, looking just at boys, we examined the odds of removal due to physical abuse, finding that boys with intellectual disabilities were fifteen percent more likely to be removed for this reason (OR=1.15, p<.001).

Placement-related characteristics and comparisons: Once youth with intellectual disabilities enter into foster care, the placement setting itself can have a significant impact on their well-being during a time of potentially traumatic transition from their regular schedules, habits and circles of support.Generally, placement decisions are to be based on the least restrictive setting possible that will meet a child’s safety needs, promote placement stability and support possible family reunification (P.L. 105-89).

Despite these foster care policy-related goals, foster youth with intellectual disabilities experienced more placement instability (measured as number of settings) than their counterparts (4 vs. 3, t=36.2, p<.001) and were more likely to be placed out-of-state (7.4 percent vs. 5.2 percent, OR=1.4, p<.001). The ideal goal for most foster youth is family reunification, yet youth with intellectual disabilities were 49 percent less likely to be placed with family in a trial home visit. While kinship foster care is often regarded as a good alternative, youth with intellectual disabilities were 61 percent less likely to live in this type of setting. Conversely, youth with intellectual disabilities were almost two times more likely to be living in a non-kinship foster family setting or a pre-adoptive foster home, although due to limitations in the AFCARS data, t is unclear whether or not a pre-adoptive home could consist of kin. In considering the placement received by foster youth with intellectual disabilities, we examined the amount of foster care payments received by family foster care providers with and without foster youth with intellectual disabilities by state, a majority of states evidenced that foster families received either a larger or equivalent subsidy when caring for a child with intellectual disabilities. Foster parents caring for youth with intellectual disabilities in Kansas ($671 vs. $1,694, t=1.65 p<.005) and Oklahoma ($155 vs. $207, t=4.07, p<.001) appeared to receive less than other foster parents, with both South Carolina and Puerto Rico trending in this direction, although these findings may relate to alternative state-specific policies allowing for funds from other sources.

With respect to congregate care settings, youth with intellectual disabilities were twice as likely to live in an ‘institution,’ but were thirty percent less likely to live in community-based group homes. Although we could not reach this level of specificity with these data, exploratory analyses of youth removed on a voluntary basis suggest that youth with intellectual disabilities were more likely to live in an institutional setting (age, gender, co-morbid disability-adjusted OR=1.27, p<.001). Although a small percentage of youth with intellectual disabilities were reported to be living independently, they were less likely to live in this type of placement than were their counterparts. On average, youth with intellectual disabilities residing in independent living settings were aged 18 (SD=2), a year older than their counterparts without intellectual disabilities (t=5.72, p<.001). Further, on average, these youth had experienced at least two more foster care years (5 years vs. 3 years, t=10.8, p<.001) than their counterparts.

Findings have implications for the prevention the removal of youth from caregivers and the promotion of community inclusion of foster youth while in foster care – let me know if you would like a copy of the article for a more in-depth discussion of these findings!